Fears have been raised over the safety of a cervical cancer vaccine which health officials plan to give all 12-year-old girls, after it was revealed that the drug has been linked to several deaths.
Three young women are reported to have died days after the drug Gardasil was administered, while the jab is also suspected of triggering "adverse reactions" in 1,700 patients. The figures were uncovered by campaigners who made a freedom of information request in the US, where the vaccine was approved for use a year ago.
Tom Fitton, the president of Judicial Watch, which extracted the data, said: "Reports on the vaccine read like a catalogue of horrors."
The women – aged 12, 19 and 22 – suffered heart attacks or blood clots after being injected with Gardasil, which protects against the sexually transmitted human papilloma virus which causes most cases of cervical cancer. Hundreds of others reported suffering what could be adverse reactions, including paralysis, seizures and miscarriages.
The news comes just days after the announcement that the drug would be added to the childhood immunisation programme.
However, it has not been conclusively proven that Gardasil had directly caused any of the deaths or reported health problems.
Nicholas Kitchin, from Gardasil, manufacturers Sanofi Pasteur MSD, said the fact that symptoms were reported after a vaccination did not necessarily mean they were caused by the vaccine.
A spokesman for the Medicines and Healthcare products Regulatory Agency said no "proven, serious new risks have been identified", but added the effects would be monitored when Gardasil is used in the UK.
Jackie Fletcher, from the vaccine damage support group Jabs, said: "Trials of this jab have mostly been on adults, so we don't have any idea of the long-term effect on children."
Dr John Oakley, a West Midlands GP, said the trials for Gardasil had been so limited that the children taking it would be like "guinea pigs".
Many health campaigners have welcomed the plan to vaccinate British girls, although there have been claims it will encourage teenagers to have sex early.
Source: Telegraph.co.uk
Sunday, November 4, 2007
Temodar and radiation extends survival
NEW YORK, Oct 29 (Reuters) - Four times as many brain cancer patients who received Schering-Plough Corp (SGP.N: Quote, Profile, Research) drug Temodar and radiation were still alive four years after being diagnosed than those who received radiation alone, researchers said on Monday.
The data come from continued observation of patients from a Phase III study whose results appeared in 2005. That 573- patient study showed twice as many patients treated with Temodar and radiation survived two years after diagnosis as those receiving only radiation.
The patients were treated for a rapidly fatal form of brain cancer called glioblastoma multiforme (GBM), which accounts for up to 25 percent of all primary brain tumors.
The follow-up analysis described on Monday showed that 12 percent of those receiving Temodar during and after radiation lived for four years, versus three percent of those receiving radiation alone.
Researchers also noted that patients who survived for four years after being diagnosed were primarily younger than 50 and in otherwise good health, meaning no prior major medical condition.
About 28 percent of such otherwise healthy and relatively young patients treated with Temodar and radiation lived for four years, compared with 7 percent of those who received only radiation.
"Since GBM patients can now live longer, oncologists are monitoring them more closely and a substantial proportion of these patients are being actively treated when their cancer returns, through a combination of treatment options," said Rene-Olivier Mirimanoff, lead author of the study and a radiation oncologist at the Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland.
The four-year follow-up data were presented in Los Angeles at a meeting of the American Society for Therapeutic Radiology and Oncology.
Source: Reuter.com
The data come from continued observation of patients from a Phase III study whose results appeared in 2005. That 573- patient study showed twice as many patients treated with Temodar and radiation survived two years after diagnosis as those receiving only radiation.
The patients were treated for a rapidly fatal form of brain cancer called glioblastoma multiforme (GBM), which accounts for up to 25 percent of all primary brain tumors.
The follow-up analysis described on Monday showed that 12 percent of those receiving Temodar during and after radiation lived for four years, versus three percent of those receiving radiation alone.
Researchers also noted that patients who survived for four years after being diagnosed were primarily younger than 50 and in otherwise good health, meaning no prior major medical condition.
About 28 percent of such otherwise healthy and relatively young patients treated with Temodar and radiation lived for four years, compared with 7 percent of those who received only radiation.
"Since GBM patients can now live longer, oncologists are monitoring them more closely and a substantial proportion of these patients are being actively treated when their cancer returns, through a combination of treatment options," said Rene-Olivier Mirimanoff, lead author of the study and a radiation oncologist at the Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland.
The four-year follow-up data were presented in Los Angeles at a meeting of the American Society for Therapeutic Radiology and Oncology.
Source: Reuter.com
FDA OKs Novartis Cancer Drug
Novartis (NVS - Cramer's Take - Stockpickr - Rating) said Monday afternoon that the Food and Drug Administration approved its second-line treatment for chronic myeloid leukemia (CML), a life-threatening blood cancer that's one of the four most common types of leukemia.
The FDA approved Tasigna for adults with Philadelphia chromosome-positive (Ph+) CML who are resistant or intolerant to prior treatment, including Novartis' Glivec.
Novartis said it will make the twice-daily drug available in the U.S. within days. It was approved in Switzerland in July 2007, and Novartis expects an approval in the European Union by the end of this year. The Committee for Medicinal Products for Human Use (CHMP), which reviews medicines in Europe, issued a positive opinion in September recommending the drug be approved. Tasigna was also submitted for approval in Japan in June.
Source: TheStreet.com
The FDA approved Tasigna for adults with Philadelphia chromosome-positive (Ph+) CML who are resistant or intolerant to prior treatment, including Novartis' Glivec.
Novartis said it will make the twice-daily drug available in the U.S. within days. It was approved in Switzerland in July 2007, and Novartis expects an approval in the European Union by the end of this year. The Committee for Medicinal Products for Human Use (CHMP), which reviews medicines in Europe, issued a positive opinion in September recommending the drug be approved. Tasigna was also submitted for approval in Japan in June.
Source: TheStreet.com
Friday, September 21, 2007
AstraZeneca's Stock May Get Help From Prostate Drug (Update1)
The following article provides a glimpse of hope for Terminal Stage Prostate Cancer Patients. The European company AstraZeneca has developed a medicine called ZD4054 that could potentially lengthen the lives of terminally ill patients. It seems that we are inching closer and closer to a cure for cancer. Just a matter of when and who.
By Eva von Schaper and Dermot Doherty
Sept. 20 (Bloomberg) -- AstraZeneca Plc is staking the growth of its flagging cancer-drug unit on a prostate tumor medicine that treats lethal forms of the disease.
The experimental therapy, called ZD4054, may lengthen the lives of terminally ill patients in a study released in Barcelona next week. The report may revive the London-based company's shares after a 12 percent decline this year.
AstraZeneca, the U.K.'s second-largest drugmaker, started the final phase of testing in June and is scheduled to file for approval in 2009. About 27,000 Americans die each year of prostate cancer, and analysts say the medicine is likely to generate $1 billion in annual sales. AstraZeneca needs new therapies after scuttling three medicines last year.
``They're not positioned to tolerate another failure with a phase III candidate,'' said Nick Turner, an analyst at Mirabaud Securities in London. ``ZD4054 is important,''
The company, once the world's largest cancer-drug maker, has fallen to fifth, according to Paul Diggle, a London-based analyst with Code Nomura. Its best-selling Arimidex and Casodex cancer treatments, with combined second-quarter sales of more than $770 million, are set to lose patent protection in 2008 and 2009.
AstraZeneca shares rose 9 pence, or 0.4 percent, to 2,427 pence at 10:41 a.m. in London trading. AstraZeneca has lost 25 percent in the past 12 months, while the 13-member Bloomberg Europe Pharmaceutical Index has declined 5.7 percent.
ZD4054 is one of several cancer medicines AstraZeneca is moving further into trials, Chief Executive Officer David Brennan said yesterday at a meeting with reporters. Testing of the drug was pushed up because scientists said it showed better activity than similar compounds in early studies, he said.
Cutting the Flow
The pressure on AstraZeneca to deliver new medicines rose after the heart drug AGI-1067 in April failed to reduce chest pain and other disease complications, the company's latest compound to fall short of its target. The experimental medicine was the fourth one shelved by Brennan. Stroke drug NXY-059, also known as Cerovive, was dropped in October 2006, following Exanta for blood clots in February and Galida for diabetes in May.
``This could be a step back to the front line of cancer for AstraZeneca,'' Diggle said. Only 8 of the 37 analysts whose coverage is tracked by Bloomberg suggest investors buy the company's shares.
The product cuts off the growth of blood vessels tumors need to spread to other organs by blocking the action of a cell protein called endothelin A. AstraZeneca, which has struggled to get wider use of its Iressa lung cancer medicine, is trying for success in a treatment area where other companies have failed.
Rival Failures
ZD4054 is the second therapy to exploit a blood-vessel blocking strategy to interfere with prostate cancer's spread. In 2005, Abbott Laboratories failed to win approval from the U.S. Food and Drug Administration for its experimental drug, Xinlay, which also sought to inhibit endothelin.
A panel of advisers said the company didn't show the drug delayed the disease. It was also linked to a risk of heart failure. Unlike Xinlay, ZD4054 doesn't hamper cell death.
``The risk is high but the reward is also high,'' said Erik Hultgard, an analyst at Kaupthing Bank in Stockholm who has a buy rating on the stock. ``AstraZeneca is very optimistic, and the data should be encouraging.''
Robert Dreicer, a Cleveland Clinic doctor who tested ZD4054, said the way Abbott conducted its study made it difficult for regulators to evaluate the product's usefulness.
``The way the trials were designed was problematic,'' Dreicer said. ``I believe the class is promising and has activity.''
Third of All Cancers
Drugmakers have had setbacks trying to develop treatments for advanced prostate cancer. U.S. regulators in May delayed Seattle-based Dendreon Corp.'s Provenge vaccine for prostate cancer, while GPC Biotech AG, a German biotechnology company, in July withdrew a U.S. application for its prostate cancer drug, satraplatin.
More than 220,000 men will be diagnosed with prostate cancer in the U.S. this year, according to the National Cancer Institute in Bethesda, Maryland. Prostate cancer accounts for about a third of all cancer diagnoses in men, second only to skin cancer.
Investors have lost confidence in AstraZeneca's pipeline after the late stage failures. Analysts estimate that investors are willing to pay about $11.92 for each dollar of AstraZeneca earnings, the second cheapest of European drugmakers. That compares to just over $20.42 for Roche, and $16.50 for Novartis, according to according to data compiled by Bloomberg.
``As many men with hormone-refractory prostate cancer are elderly and frail, we would like to have a drug that hinders hormone refractory disease with few side-effects,'' said Dr. Par Stattin, a urologist at Umea University Hospital in Umea, Sweden. ``There is a big need for such a drug.''
To contact the reporter on this story: Eva von Schaper in Munich at evonschaper@bloomberg.net ; Dermot Doherty in Geneva at Ddoherty9@bloomberg.net
source: Bloomberg.com
By Eva von Schaper and Dermot Doherty
Sept. 20 (Bloomberg) -- AstraZeneca Plc is staking the growth of its flagging cancer-drug unit on a prostate tumor medicine that treats lethal forms of the disease.
The experimental therapy, called ZD4054, may lengthen the lives of terminally ill patients in a study released in Barcelona next week. The report may revive the London-based company's shares after a 12 percent decline this year.
AstraZeneca, the U.K.'s second-largest drugmaker, started the final phase of testing in June and is scheduled to file for approval in 2009. About 27,000 Americans die each year of prostate cancer, and analysts say the medicine is likely to generate $1 billion in annual sales. AstraZeneca needs new therapies after scuttling three medicines last year.
``They're not positioned to tolerate another failure with a phase III candidate,'' said Nick Turner, an analyst at Mirabaud Securities in London. ``ZD4054 is important,''
The company, once the world's largest cancer-drug maker, has fallen to fifth, according to Paul Diggle, a London-based analyst with Code Nomura. Its best-selling Arimidex and Casodex cancer treatments, with combined second-quarter sales of more than $770 million, are set to lose patent protection in 2008 and 2009.
AstraZeneca shares rose 9 pence, or 0.4 percent, to 2,427 pence at 10:41 a.m. in London trading. AstraZeneca has lost 25 percent in the past 12 months, while the 13-member Bloomberg Europe Pharmaceutical Index has declined 5.7 percent.
ZD4054 is one of several cancer medicines AstraZeneca is moving further into trials, Chief Executive Officer David Brennan said yesterday at a meeting with reporters. Testing of the drug was pushed up because scientists said it showed better activity than similar compounds in early studies, he said.
Cutting the Flow
The pressure on AstraZeneca to deliver new medicines rose after the heart drug AGI-1067 in April failed to reduce chest pain and other disease complications, the company's latest compound to fall short of its target. The experimental medicine was the fourth one shelved by Brennan. Stroke drug NXY-059, also known as Cerovive, was dropped in October 2006, following Exanta for blood clots in February and Galida for diabetes in May.
``This could be a step back to the front line of cancer for AstraZeneca,'' Diggle said. Only 8 of the 37 analysts whose coverage is tracked by Bloomberg suggest investors buy the company's shares.
The product cuts off the growth of blood vessels tumors need to spread to other organs by blocking the action of a cell protein called endothelin A. AstraZeneca, which has struggled to get wider use of its Iressa lung cancer medicine, is trying for success in a treatment area where other companies have failed.
Rival Failures
ZD4054 is the second therapy to exploit a blood-vessel blocking strategy to interfere with prostate cancer's spread. In 2005, Abbott Laboratories failed to win approval from the U.S. Food and Drug Administration for its experimental drug, Xinlay, which also sought to inhibit endothelin.
A panel of advisers said the company didn't show the drug delayed the disease. It was also linked to a risk of heart failure. Unlike Xinlay, ZD4054 doesn't hamper cell death.
``The risk is high but the reward is also high,'' said Erik Hultgard, an analyst at Kaupthing Bank in Stockholm who has a buy rating on the stock. ``AstraZeneca is very optimistic, and the data should be encouraging.''
Robert Dreicer, a Cleveland Clinic doctor who tested ZD4054, said the way Abbott conducted its study made it difficult for regulators to evaluate the product's usefulness.
``The way the trials were designed was problematic,'' Dreicer said. ``I believe the class is promising and has activity.''
Third of All Cancers
Drugmakers have had setbacks trying to develop treatments for advanced prostate cancer. U.S. regulators in May delayed Seattle-based Dendreon Corp.'s Provenge vaccine for prostate cancer, while GPC Biotech AG, a German biotechnology company, in July withdrew a U.S. application for its prostate cancer drug, satraplatin.
More than 220,000 men will be diagnosed with prostate cancer in the U.S. this year, according to the National Cancer Institute in Bethesda, Maryland. Prostate cancer accounts for about a third of all cancer diagnoses in men, second only to skin cancer.
Investors have lost confidence in AstraZeneca's pipeline after the late stage failures. Analysts estimate that investors are willing to pay about $11.92 for each dollar of AstraZeneca earnings, the second cheapest of European drugmakers. That compares to just over $20.42 for Roche, and $16.50 for Novartis, according to according to data compiled by Bloomberg.
``As many men with hormone-refractory prostate cancer are elderly and frail, we would like to have a drug that hinders hormone refractory disease with few side-effects,'' said Dr. Par Stattin, a urologist at Umea University Hospital in Umea, Sweden. ``There is a big need for such a drug.''
To contact the reporter on this story: Eva von Schaper in Munich at evonschaper@bloomberg.net ; Dermot Doherty in Geneva at Ddoherty9@bloomberg.net
source: Bloomberg.com
Tuesday, September 18, 2007
Millennium Pharma: Velcade cancer therapy shows positive results
Sept 18 (Reuters) - Millennium Pharmaceuticals Inc (MLNM.O: Quote, Profile, Research) said data from a late-stage trial of cancer drug Velcade, in combination with certain other cancer treatments, for the treatment of multiple myeloma, showed statistically significant improvement in all efficacy measures.
In a statement, Millennium said the control arm of the trial was stopped early to allow patients still being treated with the other cancer treatments, melphalan and prednisone, to have Velcade added to their therapy.
Millennium is co-developing Velcade with a unit of Johnson & Johnson (JNJ.N: Quote, Profile, Research). (Reporting by Deepti Chaudhary in Bangalore)
Source: Reuters
In a statement, Millennium said the control arm of the trial was stopped early to allow patients still being treated with the other cancer treatments, melphalan and prednisone, to have Velcade added to their therapy.
Millennium is co-developing Velcade with a unit of Johnson & Johnson (JNJ.N: Quote, Profile, Research). (Reporting by Deepti Chaudhary in Bangalore)
Source: Reuters
Monday, September 17, 2007
FDA Warns Against Use Of Fentora In Patients With Acute Pain – Linked To Five Deaths – Breakthrough Pain Cancer Drug
Another unfortunate setback for cancer patients. The Fentora, once a promising painkiller for cancer patients, is on the verge of being taken offline.
(Best Syndication) The powerful painkiller, Fentora, which is used for treating pain in cancer patients, is linked to four deaths and a suicide, according to a spokesperson from Cephalon Inc. Fentora contains an ingredient called Fentanyl, which is eighty times more power than Morphine. The drug may have been prescribed for other conditions including migraine headaches, back and bone pain. The company now warns against that.
The Food and Drug Administration (FDA) and the drugs maker warned doctors in a letter. The drug should only be used on cancer patients who are already taking opiod drugs like Morphine. The company wants to make sure that those taking Fentor are tolerant to opiod drugs. The drug should not be prescribed for acute pain or for postoperative pain, according to the letter.
The company says do not substitute Fentora for Actiq or other fentanyl-containing products. Patients should not take more than 2 FENTORA tablets per breakthrough pain (BTP) episode. Patients must wait at leas 4 hours between treatments.
Source: Bestsyndication.com
(Best Syndication) The powerful painkiller, Fentora, which is used for treating pain in cancer patients, is linked to four deaths and a suicide, according to a spokesperson from Cephalon Inc. Fentora contains an ingredient called Fentanyl, which is eighty times more power than Morphine. The drug may have been prescribed for other conditions including migraine headaches, back and bone pain. The company now warns against that.
The Food and Drug Administration (FDA) and the drugs maker warned doctors in a letter. The drug should only be used on cancer patients who are already taking opiod drugs like Morphine. The company wants to make sure that those taking Fentor are tolerant to opiod drugs. The drug should not be prescribed for acute pain or for postoperative pain, according to the letter.
The company says do not substitute Fentora for Actiq or other fentanyl-containing products. Patients should not take more than 2 FENTORA tablets per breakthrough pain (BTP) episode. Patients must wait at leas 4 hours between treatments.
Source: Bestsyndication.com
Friday, September 14, 2007
Targeted drug combos could outsmart cancer
I found the following article very interesting and promising for cancer patients.
Thu Sep 13, 2007 4:42pm EDT
By Julie Steenhuysen
CHICAGO (Reuters) - Cancer cells often have a way of outsmarting new targeted drug therapies, but U.S. researchers said on Thursday a combination of targeted drugs could shut down a tumor's backup plan, resulting in much more effective treatments.
A number of these so-called targeted cancer drugs -- such as Roche's Tarceva and Novartis' Gleevec -- work by blocking the activity of various protein switches that tell the cell to grow. They are known as receptor tyrosine kinases or RTKs.
"They essentially allow the cell to communicate with the external world to sense growth factors that could maintain the survival of a cancer cell," said Dr. Ronald DePinho of the Dana-Farber Cancer Institute and Harvard Medical School, whose study appears in the journal Science.
These protein switches are on the surface of all cells, and they go haywire in a number of cancers.
Drugs that target a single switch have transformed the treatment of some patients with certain cancers -- for instance, Gleevec and chronic myelogenous leukemia.
But they only work in a small percentage of people. And certain tumors, including the aggressive brain cancer glioblastoma multiforme, respond poorly to such drugs.
DePinho and colleagues now believe they know why. His team studied 20 different batches of glioblastoma cells in the lab and found that many growth switches were flipped on at once.
In 19 of the 20 cell lines, three or more were switched on. They tested tumor samples from newly diagnosed cancer patients and got a similar result.
"We found there was a multitude of activated receptor tyrosine kinases," DePinho said in a telephone interview. "When you would extinguish one with a specific targeted agent, the other ones would simply step in."
'BROADLY APPLICABLE'
When they tried Gleevec, known generically as imatinib, it had little effect on the cells. But when they combined it with two other drugs -- Tarceva, known generically as erlotinib, and Pfizer's SU-11274 -- the growth signal was shut down and the cancer cells died.
"It's a very important observation scientifically and it has immediate clinical implications," DePinho said. "This is broadly applicable. This paradigm is true for virtually all solid tumors that we've looked at."
He and colleagues hope to start testing combinations of these targeted therapies in patients.
A person's tumors would be profiled first to determine which signals are active, and then doctors would pick a drug combination that would work best.
DePinho said it would take some time to get these therapies to cancer patients because the drugs used in combination might turn out to be toxic.
He agreed that a cocktail of targeted drugs would be costly. Tarceva -- approved to treat lung and pancreatic cancer -- costs around $3,000 for a 30-day supply.
But he said one of the reasons for the drugs' current high cost is the high failure rate of drug development.
"If we can use science ... to design better clinical trials, the costs will be a lot less," DePinho said.
Source: Reuters
Thu Sep 13, 2007 4:42pm EDT
By Julie Steenhuysen
CHICAGO (Reuters) - Cancer cells often have a way of outsmarting new targeted drug therapies, but U.S. researchers said on Thursday a combination of targeted drugs could shut down a tumor's backup plan, resulting in much more effective treatments.
A number of these so-called targeted cancer drugs -- such as Roche's Tarceva and Novartis' Gleevec -- work by blocking the activity of various protein switches that tell the cell to grow. They are known as receptor tyrosine kinases or RTKs.
"They essentially allow the cell to communicate with the external world to sense growth factors that could maintain the survival of a cancer cell," said Dr. Ronald DePinho of the Dana-Farber Cancer Institute and Harvard Medical School, whose study appears in the journal Science.
These protein switches are on the surface of all cells, and they go haywire in a number of cancers.
Drugs that target a single switch have transformed the treatment of some patients with certain cancers -- for instance, Gleevec and chronic myelogenous leukemia.
But they only work in a small percentage of people. And certain tumors, including the aggressive brain cancer glioblastoma multiforme, respond poorly to such drugs.
DePinho and colleagues now believe they know why. His team studied 20 different batches of glioblastoma cells in the lab and found that many growth switches were flipped on at once.
In 19 of the 20 cell lines, three or more were switched on. They tested tumor samples from newly diagnosed cancer patients and got a similar result.
"We found there was a multitude of activated receptor tyrosine kinases," DePinho said in a telephone interview. "When you would extinguish one with a specific targeted agent, the other ones would simply step in."
'BROADLY APPLICABLE'
When they tried Gleevec, known generically as imatinib, it had little effect on the cells. But when they combined it with two other drugs -- Tarceva, known generically as erlotinib, and Pfizer's SU-11274 -- the growth signal was shut down and the cancer cells died.
"It's a very important observation scientifically and it has immediate clinical implications," DePinho said. "This is broadly applicable. This paradigm is true for virtually all solid tumors that we've looked at."
He and colleagues hope to start testing combinations of these targeted therapies in patients.
A person's tumors would be profiled first to determine which signals are active, and then doctors would pick a drug combination that would work best.
DePinho said it would take some time to get these therapies to cancer patients because the drugs used in combination might turn out to be toxic.
He agreed that a cocktail of targeted drugs would be costly. Tarceva -- approved to treat lung and pancreatic cancer -- costs around $3,000 for a 30-day supply.
But he said one of the reasons for the drugs' current high cost is the high failure rate of drug development.
"If we can use science ... to design better clinical trials, the costs will be a lot less," DePinho said.
Source: Reuters
Wednesday, September 12, 2007
New Treatments for Lung Cancer
New Treatments for Lung Cancer
If you look at the changing incidence of lung cancer in men, you can see that the United Kingdom is actually decreasing quite substantially from the earlier 1960s and '70s. In the United States, lung cancer has actually leveled off in the 1980s and it has started to decline in the last couple of years and in France it is still rising. So it really just depends on where you are and on your habits. In women, lung cancer in the United States is still going up.
If we look at the types of lung cancer, lung cancer is obviously not all one disease but there are two major types: non small cell and small cell. Approximately 75-80% of the tumors that we see are non small cell, while only 20-25% are small cell itself. If we look at the small cell subtypes, previously the vast majority of those particularly with the disease found in males was squamous cell cancer but more recently the majority of them are adenocarcinomas and 40% of all lung cancers are adenocarcinomas. So this has really shot up and changed the nature of the disease as well. Squamous cell is only 17% of all lung cancers at this point.
This is a complicated slide but if we look at males over here and females over here and the left one is smokers and the right one is nonsmokers, you see that the incidence of different subtypes is different. In smokers, particularly males, again squamous cell is a fairly predominant tumor type. But if we look at nonsmokers, adenocarcinoma is by far the most common subtype. The same is true of females even to a greater extent. In smokers, adenocarcinoma is more common in canser.
I am going start talking about stage 3-A and go down here and then come back to stage 1 and 2 because you will see some of the applications that have developed for advanced disease are now being applied to earlier stage disease. So, stage 1 and 2 are localized to the lung itself. Stage 3A is more advanced with neostile metastases in general or chest wall invasion and 3B is unfortunately your unresectable tumors. The change I have heard recently is this group here, T3N0 which is tumors that involve the parietal pleura either on the chest wall, the diaphragm or the mediastinum, now it is considered to be stage 2 as well since the survival is actually better. In these two groups up here, TI and T2, each one has been divided into A and B. Now, there is 1A, 1B, 2A, 2B and then T3 can be observed in 2B.
Well, the stages Y this goes from stage 1 and we will go over each stage separately, this is now over here T1N0 stage 1A. The tumors have to be less than 3 cm and it can't involve a major lobar bronchus and create lobar atelectasis or consolidation.
Stage 2 is the same two groups except for there is intrapulmonary lymph node involvement so that the criteria are the same. This is 2A, this is 2B but there is intrapulmonary lymph nodes either along the segmental bronchi or either the lobar bronchi.
This is 3A. This is locally advanced now. We are at T3N0 again goes to the 2B now but T3N1 and 2, T3 involves basically anything that has parietal pleura. That is the chest wall, the diaphragm or the mediastinum without involving major organs.
The other component of a 3A is N2 disease and that means now lymph nodes up in this area that are involved. So you can kind of get a feeling from the number of different subgroups in this phase that there are a lot of different patient populations in here. N2 disease is a lot different from T3 disease so implications in terms of survival and treatment are also different.
3B again is something that is unresectable in general which includes N3 disease which is either contralateral, if you have a tumor over here, contralateral lymph node involvement on the opposite side or a scalene lymph nodes in this particular area or you have a T4 lesion which is either a tumor growing into a major structure like an aorta, esophagus, left atrium or some major unresectable organ or a malignant pleural effusion. So those are the two criteria for 3B.
One of the things surgeons keep in mind is the spread of tumors along lymph node chains.
To view the full article, follow this link:
medical-library.org
If you look at the changing incidence of lung cancer in men, you can see that the United Kingdom is actually decreasing quite substantially from the earlier 1960s and '70s. In the United States, lung cancer has actually leveled off in the 1980s and it has started to decline in the last couple of years and in France it is still rising. So it really just depends on where you are and on your habits. In women, lung cancer in the United States is still going up.
If we look at the types of lung cancer, lung cancer is obviously not all one disease but there are two major types: non small cell and small cell. Approximately 75-80% of the tumors that we see are non small cell, while only 20-25% are small cell itself. If we look at the small cell subtypes, previously the vast majority of those particularly with the disease found in males was squamous cell cancer but more recently the majority of them are adenocarcinomas and 40% of all lung cancers are adenocarcinomas. So this has really shot up and changed the nature of the disease as well. Squamous cell is only 17% of all lung cancers at this point.
This is a complicated slide but if we look at males over here and females over here and the left one is smokers and the right one is nonsmokers, you see that the incidence of different subtypes is different. In smokers, particularly males, again squamous cell is a fairly predominant tumor type. But if we look at nonsmokers, adenocarcinoma is by far the most common subtype. The same is true of females even to a greater extent. In smokers, adenocarcinoma is more common in canser.
I am going start talking about stage 3-A and go down here and then come back to stage 1 and 2 because you will see some of the applications that have developed for advanced disease are now being applied to earlier stage disease. So, stage 1 and 2 are localized to the lung itself. Stage 3A is more advanced with neostile metastases in general or chest wall invasion and 3B is unfortunately your unresectable tumors. The change I have heard recently is this group here, T3N0 which is tumors that involve the parietal pleura either on the chest wall, the diaphragm or the mediastinum, now it is considered to be stage 2 as well since the survival is actually better. In these two groups up here, TI and T2, each one has been divided into A and B. Now, there is 1A, 1B, 2A, 2B and then T3 can be observed in 2B.
Well, the stages Y this goes from stage 1 and we will go over each stage separately, this is now over here T1N0 stage 1A. The tumors have to be less than 3 cm and it can't involve a major lobar bronchus and create lobar atelectasis or consolidation.
Stage 2 is the same two groups except for there is intrapulmonary lymph node involvement so that the criteria are the same. This is 2A, this is 2B but there is intrapulmonary lymph nodes either along the segmental bronchi or either the lobar bronchi.
This is 3A. This is locally advanced now. We are at T3N0 again goes to the 2B now but T3N1 and 2, T3 involves basically anything that has parietal pleura. That is the chest wall, the diaphragm or the mediastinum without involving major organs.
The other component of a 3A is N2 disease and that means now lymph nodes up in this area that are involved. So you can kind of get a feeling from the number of different subgroups in this phase that there are a lot of different patient populations in here. N2 disease is a lot different from T3 disease so implications in terms of survival and treatment are also different.
3B again is something that is unresectable in general which includes N3 disease which is either contralateral, if you have a tumor over here, contralateral lymph node involvement on the opposite side or a scalene lymph nodes in this particular area or you have a T4 lesion which is either a tumor growing into a major structure like an aorta, esophagus, left atrium or some major unresectable organ or a malignant pleural effusion. So those are the two criteria for 3B.
One of the things surgeons keep in mind is the spread of tumors along lymph node chains.
To view the full article, follow this link:
medical-library.org
Tuesday, September 11, 2007
Prostate Cancer
Background
Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. It occurs when cells of the prostate mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, erectile dysfunction and other symptoms.
Prostate cancer develops most frequently in men over fifty. This cancer can occur only in men, as the prostate is exclusively of the male reproductive tract. It is the most common type of cancer in men in the United States, where it is responsible for more male deaths than any other cancer, except lung cancer. However, many men who develop prostate cancer never have symptoms, undergo no therapy, and eventually die of other causes. Many factors, including genetics and diet, have been implicated in the development of prostate cancer.
Symptoms
Early prostate cancer usually causes no symptoms. Often it is diagnosed during the workup for an elevated PSA noticed during a routine checkup. Sometimes, however, prostate cancer does cause symptoms, often similar to those of diseases such as benign prostatic hypertrophy. These include frequent urination, increased urination at night, difficulty starting and maintaining a steady stream of urine, blood in the urine, and painful urination. Prostate cancer may also cause problems with sexual function, such as difficulty achieving erection or painful ejaculation.
Several medications and vitamins may also help prevent prostate cancer. Two dietary supplements, vitamin E and selenium, may help prevent prostate cancer when taken daily. Estrogens from fermented soybeans and other plant sources (called phytoestrogens) may also help prevent prostate cancer. The selective estrogen receptor modulator drug toremifene has shown promise in early trials. Two medications which block the conversion of testosterone to dihydrotestosterone, finasteride and dutasteride,[38] have also shown some promise. As of 2006 the use of these medications for primary prevention is still in the testing phase, and they are not widely used for this purpose. The problem with these medications is that they may preferentially block the development of lower-grade prostate tumors, leading to a relatively greater chance of higher grade cancers, and negating any overall survival improvement. Green tea may be protective (due to its polyphenol content), though the data is mixed.[39][40] A 2006 study of green tea derivatives demonstrated promising prostate cancer prevention in patients at high risk for the disease. In 2003, an Australian research team led by Graham Giles of The Cancer Council Australia concluded that frequent masturbation by males appears to help prevent the development of prostate cancer. Recent research published in the Journal of the National Cancer Institute suggests that taking multivitamins more than seven times a week can increase the risks of contracting the disease. This research was unable to highlight the exact vitamins responsible for this increase (almost double), although they suggest that vitamin A, vitamin E and beta-carotene may lie at its heart. It is advised that those taking multivitamins never exceed the stated daily dose on the label. Scientists recommend a healthy, well balanced diet rich in fiber, and to reduce intake of meat. A 2007 study published in the Journal of the National Cancer Institute found that men eating cauliflower, broccoli, or one of the other cruciferous vegetables, more than once a week were 40% less likely to develop prostate cancer than men who rarely ate those vegetables. Scientists believe the reason for this phenomenon has to do with a phytochemical called Diindolylmethane in these vegetables that has anti-androgenic and immune modulating properties. This compound is currently under investigation by the National Cancer Institute as a natural therapeutic for prostate cancer.
When normal cells are damaged beyond repair, they are eliminated by apoptosis. Cancer cells avoid apoptosis and continue to multiply in an unregulated manner.
Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. It occurs when cells of the prostate mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, erectile dysfunction and other symptoms.
Prostate cancer develops most frequently in men over fifty. This cancer can occur only in men, as the prostate is exclusively of the male reproductive tract. It is the most common type of cancer in men in the United States, where it is responsible for more male deaths than any other cancer, except lung cancer. However, many men who develop prostate cancer never have symptoms, undergo no therapy, and eventually die of other causes. Many factors, including genetics and diet, have been implicated in the development of prostate cancer.
Symptoms
Early prostate cancer usually causes no symptoms. Often it is diagnosed during the workup for an elevated PSA noticed during a routine checkup. Sometimes, however, prostate cancer does cause symptoms, often similar to those of diseases such as benign prostatic hypertrophy. These include frequent urination, increased urination at night, difficulty starting and maintaining a steady stream of urine, blood in the urine, and painful urination. Prostate cancer may also cause problems with sexual function, such as difficulty achieving erection or painful ejaculation.
Advanced prostate cancer may cause additional symptoms as the disease spreads to other parts of the body. The most common symptom is bone pain, often in the vertebrae (bones of the spine), pelvis or ribs, from cancer which has spread to these bones. Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and fecal incontinence.
PreventionSeveral medications and vitamins may also help prevent prostate cancer. Two dietary supplements, vitamin E and selenium, may help prevent prostate cancer when taken daily. Estrogens from fermented soybeans and other plant sources (called phytoestrogens) may also help prevent prostate cancer. The selective estrogen receptor modulator drug toremifene has shown promise in early trials. Two medications which block the conversion of testosterone to dihydrotestosterone, finasteride and dutasteride,[38] have also shown some promise. As of 2006 the use of these medications for primary prevention is still in the testing phase, and they are not widely used for this purpose. The problem with these medications is that they may preferentially block the development of lower-grade prostate tumors, leading to a relatively greater chance of higher grade cancers, and negating any overall survival improvement. Green tea may be protective (due to its polyphenol content), though the data is mixed.[39][40] A 2006 study of green tea derivatives demonstrated promising prostate cancer prevention in patients at high risk for the disease. In 2003, an Australian research team led by Graham Giles of The Cancer Council Australia concluded that frequent masturbation by males appears to help prevent the development of prostate cancer. Recent research published in the Journal of the National Cancer Institute suggests that taking multivitamins more than seven times a week can increase the risks of contracting the disease. This research was unable to highlight the exact vitamins responsible for this increase (almost double), although they suggest that vitamin A, vitamin E and beta-carotene may lie at its heart. It is advised that those taking multivitamins never exceed the stated daily dose on the label. Scientists recommend a healthy, well balanced diet rich in fiber, and to reduce intake of meat. A 2007 study published in the Journal of the National Cancer Institute found that men eating cauliflower, broccoli, or one of the other cruciferous vegetables, more than once a week were 40% less likely to develop prostate cancer than men who rarely ate those vegetables. Scientists believe the reason for this phenomenon has to do with a phytochemical called Diindolylmethane in these vegetables that has anti-androgenic and immune modulating properties. This compound is currently under investigation by the National Cancer Institute as a natural therapeutic for prostate cancer.
Source: Wikipedia.org
Lung Cancer Symptoms
Background
Lung cancer, or more specifically carcinoma of the lung, is a disease where epithelial (internal lining) tissue in the lung grows out of control. This leads to invasion of adjacent tissue and infiltration beyond the lungs (metastasis). Lung cancer, the most common cause of cancer-related death in men and the second most common in women, is responsible for 1.3 million deaths worldwide annually. The most common symptoms are shortness of breath, cough (including coughing up blood), and weight loss.
The main types of lung cancer are small cell lung cancer and non-small cell lung cancer. This distinction is important because non-small cell lung cancer is sometimes treated with surgery, while small cell cancer is not. Also, small cell lung cancer usually responds better to chemotherapy.
The most important cause of lung cancer is exposure to tobacco smoke.The occurrence of lung cancer in non-smokers, who account for less than 10% of cases, appears to be due to a combination of genetic factors. Radon gas, asbestos,and air pollution may also contribute to the development of lung cancer.
Lung cancer may be seen on chest x-ray and CT scan. The diagnosis is confirmed with a biopsy. This is usually performed via bronchoscopy or CT-guided biopsy.
Treatment and prognosis depend upon the histological type of cancer, the stage (degree of spread), and the patient's performance status. Possible treatments include surgery, chemotherapy, and radiotherapy. Even with treatment, the overall five-year survival rate is 14%.
ClassificationThe vast majority of lung cancers are carcinomas, namely malignancies that arise from epithelial cells. There are two main types of lung carcinoma categorized by the size and appearance of the malignant cells seen by a histopathologist under a microscope: non-small cell (80%) and small-cell (roughly 20%) lung cancer. This classification, although based on simple histological criteria, has very important implications for clinical management and prognosis of the disease.
Rarer forms of lung cancer include carcinoid, adenoid cystic carcinoma (cylindroma) and mucoepidermoid carcinoma.
Non-small cell lung cancer (NSCLC)
The non-small cell lung cancers are grouped together because their prognosis and management are similar. There are three main sub-types: squamous cell lung carcinoma, adenocarcinoma and large cell lung carcinoma. When NSCLC cannot be subtyped, it is assigned SNOMED code 8046/3.
Accounting for 29% of lung cancers, squamous cell lung carcinoma usually starts near a central bronchus. Cavitation and necrosis within the center of the cancer is a common finding. Well-differentiated squamous cell lung cancers often grow more slowly than other cancer types.
Adenocarcinoma is the most common subtype of NSCLC, accounting for 32% of lung cancers. It usually originates in peripheral lung tissue. Most cases of adenocarcinoma are associated with smoking. However, among people who have never smoked ("never-smokers"), adenocarcinoma is the most common form of lung cancer. A subtype of adenocarcinoma, the bronchioloalveolar carcinoma, is more common in female never-smokers, and may have different responses to treatment.
Accounting for 9% of lung cancers, large cell lung carcinoma is a fast-growing form that grows near the surface of the lung. It is often poorly differentiated and tends to metastasize early.
Small cell lung cancer (SCLC)
small cell lung carcinoma (microscopic view of a core needle biopsy)
Small cell lung cancer (SCLC, also called "oat cell carcinoma") is less common. It tends to arise in the larger breathing tubes and grows rapidly, becoming quite large. The "oat" cell contains dense neurosecretory granules which give this an endocrine/paraneoplastic syndrome association. While initially more sensitive to chemotherapy, it ultimately carries a worse prognosis and is often metastatic at presentation. This type of lung cancer is strongly associated with smoking.
Metastatic cancers
The lung is a common place for metastasis from tumors in other parts of the body. These cancers are identified by the site of origin, thus a breast cancer metastasis to the lung is still known as breast cancer. They often have a characteristic round appearance on chest x-ray.
Primary lung tumors themselves most commonly metastatize to the adrenal glands, liver, brain, and bone.
Staging
- See also: Non-small cell lung cancer staging
Lung cancer staging is an assessment of the degree of spread of the cancer from its original source. It is an important factor affecting the prognosis and potential treatment of lung cancer.
Non-small cell lung cancer is staged from IA ("one A", best prognosis) to IV ("four", worst prognosis). Small cell lung cancer is classified as limited stage if it is confined to one half of the chest and within the scope of a single radiotherapy field. Otherwise it is extensive stage.
Symptoms
If the cancer grows in the airway, it may obstruct airflow, causing breathing difficulties. This can lead to accumulation of secretions behind the blockage, predisposing the patient to pneumonia.
Many lung cancers have a rich blood supply. The surface of the cancer may be fragile, leading to bleeding from the cancer into the airway. This blood may subsequently be coughed up.
Depending on the type of tumor, so-called paraneoplastic phenomena may initially attract attention to the disease. In lung cancer, these phenomena may include Lambert-Eaton myasthenic syndrome (muscle weakness due to auto-antibodies), hypercalcemia or SIADH. Tumors in the top (apex) of the lung, known as Pancoast tumors, may invade the local part of the sympathetic nervous system, leading to changed sweating patterns and eye muscle problems (a combination known as Horner's syndrome), as well as muscle weakness in the hands due to invasion of the brachial plexus.
Many of the symptoms of lung cancer (bone pain, fever, weight loss) are nonspecific; in the elderly, these may be attributed to comorbid illness. In many patients, the cancer has already spread beyond the original site by the time they have symptoms and seek medical attention. Common sites of metastasis include the bone, such as the spine (causing back pain and occasionally spinal cord compression), the liver and the brain. About 10% of people with lung cancer do not have symptoms of it at the time of diagnosis; these cancers are usually found on routine chest x-rays.
Preventions
- See also: Smoking ban and List of smoking bans
Prevention is the most cost-effective means of fighting lung cancer. While in most countries industrial and domestic carcinogens have been identified and banned, tobacco smoking is still widespread. Eliminating tobacco smoking is a primary goal in the prevention of lung cancer, and smoking cessation is an important preventative tool in this process.
Policy interventions to decrease passive smoking in public areas such as restaurants and workplaces have become more common in many Western countries, with California taking a lead in banning smoking in public establishments in 1998, Ireland playing a similar role in Europe in 2004, followed by Italy and Norway in 2005, Scotland as well as several others in 2006, and England in 2007. New Zealand has also recently banned smoking in public places.
The state of Bhutan has had a complete smoking ban since 2005. In many countries, pressure groups are campaigning for similar bans. Arguments cited against such bans are criminalisation of smoking, increased risk of smuggling and the risk that such a ban cannot be enforced.
Screening
Screening refers to the use of medical tests to detect disease in asymptomatic people. Possible screening tests for lung cancer include chest x-ray or computed tomography (CT) of the chest. So far, screening programs for lung cancer have not demonstrated any clear benefit. Randomized controlled trials are underway in this area to see if decreased long-term mortality can be directly observed from CT screening.
source: Wikipedia.org
TB Symptoms
Background
Tuberculosis (abbreviated as TB for tubercle bacillus or TuBerculosis) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. Tuberculosis most commonly attacks the lungs (as pulmonary TB) but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, bones, joints and even the skin. Other mycobacteria such as Mycobacterium bovis, Mycobacterium africanum, Mycobacterium canetti, and Mycobacterium microti can also cause tuberculosis, but these species do not usually infect healthy adults.
Over one-third of the world's population now carries the TB bacterium, and new infections occur at a rate of one per second. Not everyone infected develops the full-blown disease, so asymptomatic, latent TB infection is most common. However, one in ten latent infections will progress to active TB disease, which, if left untreated, kills more than half of its victims.
In 2004, mortality and morbidity statistics included 14.6 million chronic active TB cases, 8.9 million new cases, and 1.6 million deaths, mostly in developing countries. In addition, a rising number of people in the developed world are contracting tuberculosis because their immune systems are compromised by immunosuppressive drugs, substance abuse or HIV/AIDS.
SymptomsWhen the disease becomes active, 75% of the cases are pulmonary TB. Symptoms include chest pain, coughing up blood, and a productive, prolonged cough for more than three weeks. Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, pallor, and often a tendency to fatigue very easily.
In the other 25% of active cases, the infection moves from the lungs, causing other kinds of TB more common in immunosuppressed persons and young children. Extrapulmonary infection sites include the pleura, the central nervous system in meningitis, the lymphatic system in scrofula of the neck, the genitourinary system in urogenital tuberculosis, and bones and joints in Pott's disease of the spine. An especially serious form is disseminated TB, more commonly known as miliary tuberculosis. Although extrapulmonary TB is not contagious, it may co-exist with pulmonary TB, which is contagious.
Prevention
TB prevention and control takes two parallel approaches. In the first, people with TB and their contacts are identified and then treated. Identification of infections often involves testing high-risk groups for TB. In the second approach, children are vaccinated to protect them from TB. Unfortunately, no vaccine is available that provides reliable protection for adults. However, in tropical areas where the incidence of atypical mycobacteria is high, exposure to nontuberculous mycobacteria gives some protection against TB.
Vaccines
Many countries use BCG vaccine as part of their TB control programs, especially for infants. This was the first vaccine for TB and developed at the Pasteur Institute in France between 1905 and 1921. However, mass vaccination with BCG did not start until after World War II. The protective efficacy of BCG for preventing serious forms of TB (e.g. meningitis) in children is greater than 80%; its protective efficacy for preventing pulmonary TB in adolescents and adults is variable, ranging from 0 to 80%.
In South Africa, the country with the highest prevalence of TB, BCG is given to all children under the age of three. However, the effectiveness of BCG is lower in areas where mycobacteria are less prevalent, therefore BCG is not given to the entire population in these countries. In the USA, for example, BCG vaccine is not recommended except for people who meet specific criteria:
- Infants or children with negative skin-test result who are continually exposed to untreated or ineffectively treated patients or will be continually exposed to multidrug-resistant TB.
- Healthcare workers considered on an individual basis in settings in which high percentage of MDR-TB patients has been found, transmission of MDR-TB is likely, and TB control precautions have been implemented and not successful.
Several new vaccines to prevent TB infection are being developed. The first recombinant tuberculosis vaccine entered clinical trials in the United States in 2004, sponsored by the National Institute of Allergy and Infectious Diseases (NIAID). A 2005 study showed that a DNA TB vaccine given with conventional chemotherapy can accelerate the disappearance of bacteria as well as protect against re-infection in mice; it may take four to five years to be available in humans. A very promising TB vaccine, MVA85A, is currently in phase II trials in South Africa by a group led by Oxford University, and is based on a genetically modified vaccinia virus. Because of the limitations of current vaccines, researchers and policymakers are promoting new economic models of vaccine development including prizes, tax incentives and advance market commitments.
Source: Wikipedia.org
How to take good care of your health
Each year more than 91.6 million people die of different types of diseases, and many of them die because they did not know they had it until too late. Therefore, it is imperative that people, young or old, learn of the different symptoms of the major diseases so that when they see or experience it, they can inform their doctor and receive appropriate treatment immediately. The purpose of this blog site is to provide information on disease symptoms and preventions. Provided below is a table listing diseases by death rate.
1.^ Group is a value showing the relationship of groups of causes. For instance, statistics for "A" (cardiovascular diseases) include those for "A.1" (ischemic heart disease), "A.2" (cerebrovascular disease), and so on. If no value is shown for a cause, there are no other causes grouped with that cause.
Group | Cause | Percent of deaths | Deaths per 100,000 per year | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| All | Male | Female | |||||||||||||||||||
| – | All causes | 100.00 | 916.1 | 954.7 | 877.1 | ||||||||||||||||
| A | Cardiovascular diseases | 29.34 | 268.8 | 259.3 | 278.4 | ||||||||||||||||
| B | Infectious and parasitic diseases | 19.12 | 175.2 | 185.1 | 165.1 | ||||||||||||||||
| A.1 | Ischemic heart disease | 12.64 | 115.8 | 121.4 | 110.1 | ||||||||||||||||
| C | Malignant neoplasms (cancers) | 12.49 | 114.4 | 126.9 | 101.7 | ||||||||||||||||
| A.2 | Cerebrovascular disease (Stroke) | 9.66 | 88.5 | 81.4 | 95.6 | ||||||||||||||||
| B.1 | Respiratory infections | 6.95 | 63.7 | 63.5 | 63.8 | ||||||||||||||||
| B.1.1 | Lower respiratory tract infections | 6.81 | 62.4 | 62.2 | 62.6 | ||||||||||||||||
| D | Respiratory diseases | 6.49 | 59.5 | 61.1 | 57.9 | ||||||||||||||||
| E | Unintentional injuries | 6.23 | 57.0 | 73.7 | 40.2 | ||||||||||||||||
| B.2 | HIV/AIDS | 4.87 | 44.6 | 46.2 | 43.0 | ||||||||||||||||
| D.1 | Chronic obstructive pulmonary disease | 4.82 | 44.1 | 45.1 | 43.1 | ||||||||||||||||
| – | Perinatal conditions | 4.32 | 39.6 | 43.7 | 35.4 | ||||||||||||||||
| F | Digestive diseases | 3.45 | 31.6 | 34.9 | 28.2 | ||||||||||||||||
| B.3 | Diarrheal diseases | 3.15 | 28.9 | 30.0 | 27.8 | ||||||||||||||||
| G | Intentional injuries (suicide, murder, war, etc.) | 2.84 | 26.0 | 37.0 | 14.9 | ||||||||||||||||
| B.4 | Tuberculosis | 2.75 | 25.2 | 32.9 | 17.3 | ||||||||||||||||
| B.5 | Malaria | 2.23 | 20.4 | 19.4 | 21.5 | ||||||||||||||||
| C.1 | Lung cancers | 2.18 | 20.0 | 28.4 | 11.4 | ||||||||||||||||
| E.1 | Road traffic accidents | 2.09 | 19.1 | 27.8 | 10.4 | ||||||||||||||||
| B.6 | Childhood diseases | 1.97 | 18.1 | 18.0 | 18.2 | ||||||||||||||||
| H | Neuropsychiatric disorders | 1.95 | 17.9 | 18.4 | 17.3 | ||||||||||||||||
| – | Diabetes mellitus | 1.73 | 15.9 | 14.1 | 17.7 | ||||||||||||||||
| A.3 | Hypertensive heart disease | 1.60 | 14.6 | 13.4 | 15.9 | ||||||||||||||||
| G.1 | Suicide | 1.53 | 14.0 | 17.4 | 10.6 | ||||||||||||||||
| C.2 | Stomach cancer | 1.49 | 13.7 | 16.7 | 10.5 | ||||||||||||||||
| I | Diseases of the genitourinary system | 1.49 | 13.6 | 14.1 | 13.1 | ||||||||||||||||
| F.1 | Cirrhosis of the liver | 1.38 | 12.6 | 16.1 | 9.1 | ||||||||||||||||
| I.1 | Nephritis/nephropathy | 1.19 | 10.9 | 11.0 | 10.7 | ||||||||||||||||
| C.3 | Colorectal cancer | 1.09 | 10.0 | 10.3 | 9.7 | ||||||||||||||||
| C.4 | Liver cancer | 1.08 | 9.9 | 13.6 | 6.2 | ||||||||||||||||
| B.6.1 | Measles | 1.07 | 9.8 | 9.8 | 9.9 | ||||||||||||||||
| G.2 | Violence | 0.98 | 9.0 | 14.2 | 3.7 | ||||||||||||||||
| – | Maternal conditions | 0.89 | 8.2 | 0.0 | 16.5 | ||||||||||||||||
| – | Congenital abnormalities | 0.86 | 7.9 | 8.1 | 7.7 | ||||||||||||||||
| J | Nutritional deficiencies | 0.85 | 7.8 | 6.9 | 8.7 | ||||||||||||||||
| C.5 | Breast cancer | 0.84 | 7.7 | 0.1 | 15.3 | ||||||||||||||||
| C.6 | Esophageal cancer | 0.78 | 7.2 | 9.1 | 5.2 | ||||||||||||||||
| A.4 | Inflammatory heart disease | 0.71 | 6.5 | 6.7 | 6.2 | ||||||||||||||||
| H.1 | Alzheimer's disease and other dementias | 0.70 | 6.4 | 4.7 | 8.1 | ||||||||||||||||
| E.2 | Falls | 0.69 | 6.3 | 7.5 | 5.0 | ||||||||||||||||
| E.3 | Drowning | 0.67 | 6.1 | 8.4 | 3.9 | ||||||||||||||||
| E.4 | Poisoning | 0.61 | 5.6 | 7.2 | 4.0 | ||||||||||||||||
| C.7 | Lymphomas, multiple myeloma | 0.59 | 5.4 | 5.4 | 5.4 | ||||||||||||||||
| A.5 | Rheumatic heart disease | 0.57 | 5.3 | 4.4 | 6.1 | ||||||||||||||||
| C.8 | Oral cancers and oropharynx cancers | 0.56 | 5.1 | 7.1 | 3.1 | ||||||||||||||||
| E.5 | Fires | 0.55 | 5.0 | 3.8 | 6.2 | ||||||||||||||||
| B.6.2 | Pertussis | 0.52 | 4.7 | 4.7 | 4.8 | ||||||||||||||||
| C.9 | Prostate cancer | 0.47 | 4.3 | 8.6 | 0.0 | ||||||||||||||||
| C.10 | Leukemia | 0.46 | 4.2 | 4.7 | 3.8 | ||||||||||||||||
| F.2 | Peptic ulcer disease | 0.46 | 4.2 | 5.0 | 3.5 | ||||||||||||||||
| J.1 | Protein-energy malnutrition | 0.46 | 4.2 | 4.2 | 4.2 | ||||||||||||||||
| – | Endocrine/nutritional disorders | 0.43 | 3.9 | 3.4 | 4.4 | ||||||||||||||||
| D.2 | Asthma | 0.42 | 3.9 | 3.9 | 3.8 | ||||||||||||||||
| C.11 | Cervical cancer | 0.42 | 3.8 | 0.0 | 7.7 | ||||||||||||||||
| C.12 | Pancreatic cancer | 0.41 | 3.7 | 3.9 | 3.5 | ||||||||||||||||
| B.6.3 | Tetanus | 0.38 | 3.4 | 3.4 | 3.5 | ||||||||||||||||
| B.7 | Sexually transmitted diseases excluding HIV | 0.32 | 2.9 | 2.9 | 2.9 | ||||||||||||||||
| C.13 | Bladder cancer | 0.31 | 2.9 | 4.0 | 1.7 | ||||||||||||||||
| B.8 | Meningitis | 0.30 | 2.8 | 2.9 | 2.7 | ||||||||||||||||
| G.3 | War | 0.30 | 2.8 | 5.0 | 0.5 | ||||||||||||||||
| B.7.1 | Syphilis | 0.28 | 2.5 | 2.7 | 2.3 | ||||||||||||||||
| – | Neoplasms other than malignant | 0.26 | 2.4 | 2.4 | 2.4 | ||||||||||||||||
| J.2 | Iron deficiency anemia | 0.24 | 2.2 | 1.5 | 2.9 | ||||||||||||||||
| C.14 | Ovarian cancer | 0.24 | 2.2 | 0.0 | 4.4 | ||||||||||||||||
| B.9 | Tropical diseases | 0.23 | 2.1 | 2.5 | 1.6 | ||||||||||||||||
| H.2 | Epilepsy | 0.22 | 2.0 | 2.2 | 1.8 | ||||||||||||||||
| – | Musculoskeletal diseases | 0.19 | 1.7 | 1.2 | 2.2 | ||||||||||||||||
| B.10 | Hepatitis B | 0.18 | 1.7 | 2.3 | 1.0 | ||||||||||||||||
| H.3 | Parkinson's disease | 0.17 | 1.6 | 1.6 | 1.6 | ||||||||||||||||
| H.4 | Alcohol use disorders | 0.16 | 1.5 | 2.5 | 0.4 | ||||||||||||||||
| H.5 | Drug use disorders | 0.15 | 1.4 | 2.2 | 0.5 | ||||||||||||||||
| B.1.2 | Upper respiratory infections | 0.13 | 1.2 | 1.2 | 1.2 | ||||||||||||||||
| C.15 | Uterine cancer | 0.12 | 1.1 | 0.0 | 2.3 | ||||||||||||||||
| – | Skin diseases | 0.12 | 1.1 | 0.8 | 1.4 | ||||||||||||||||
| C.16 | Melanoma and other skin cancers | 0.12 | 1.1 | 1.1 | 1.0 | ||||||||||||||||
| B.11 | Hepatitis C | 0.09 | 0.9 | 1.1 | 0.6 | ||||||||||||||||
| B.9.1 | Leishmaniasis | 0.09 | 0.8 | 1.0 | 0.7 | ||||||||||||||||
| B.9.2 | Trypanosomiasis | 0.08 | 0.8 | 1.0 | 0.5 | ||||||||||||||||
| I.2 | Benign prostatic hyperplasia | 0.06 | 0.5 | 1.0 | 0.0 | ||||||||||||||||
1.^ Group is a value showing the relationship of groups of causes. For instance, statistics for "A" (cardiovascular diseases) include those for "A.1" (ischemic heart disease), "A.2" (cerebrovascular disease), and so on. If no value is shown for a cause, there are no other causes grouped with that cause.
Source: World Health Organization, 2004.
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